Prevalence of self-reported xerostomia in across-sectional

population in the western province of Saudi Arabia

Nathanael Salako,* BDS, MSc, FDS, RCPS, FMCRS, FWACS
Jamila Farsi,** BDS, MS, PhD
*Faculty of Dentistry, Kuwait University, Kuwait
**Faculty of Dentistry, King Abdulaziz University , Jeddah, Saudi Arabia

The prevalence and incidence of xerostomia has been determined in many countries of the world. No data is available on a prevalence and incidence of xerostomia in any Saudi Arabian Population.  This paper describes incidence of this symptom and associated factors in the western region of Saudi Arabia - a country with very hot and dry climate throughout most of the year. A questionnaire survey was conducted in the western region of Saudi Arabia. A total of 552 responses were received and analyzed.  Results showed that the incidence of xerostomia was comparable to those reported from different parts of the world with different climatic conditions.  In accordance with other reports, our results also showed an association with other oral and non-oral symptoms, the use of certain medications and mouth habits such as cigarettes and tobacco use.
 

The perceived feeling of oral dryness is known as xerostomia. This sensation may occur in the presence or absence of salivary gland hypofunction.^1,2  The most frequent causes of dry mouth include the use of certain drugs, autoimmune diseases such as sicca syndrome, Sjogren's syndrome and irradiation of the salivary glands.

Dry mouth has been associated with several oral symptoms and signs such as burning sensation of the oral mucosa and the tongue, difficulties with swallowing, speech disorder, difficulty in eating dry food and alteration of taste.^3,4

The prevalence of xerostomia varies in different age groups and populations all over the world.  Most of the reported studies in the literature were conducted on institutionalized or aged population.^5-7 However, Sreebny et al.^3,8 showed that dry mouth could be found in all age groups and that the symptoms of oral dryness is a valid indicator of salivary gland hypofunction.

Saudi Arabia is a country with a very hot climate most months of the year. In the western region, the weather is mostly hot and could be very humid. It is therefore conceivable that the perceived feeling of oral dryness may be more rampant in the Saudi Arabian population than in the temperate regions of the world.

The objectives of this study were to determine (1) the incidence of oral dryness in different age-groups of the adolescent and adult Saudi Arabian populations; (2) the relationship between oral dryness and other selected oral and non-oral symptoms as well as the use of medications.

Subjects

The subjects were drawn from a pool of university students who were conveniently selected. Each student received information on the questionnaires and acted as the source of information collection from members of their families who were aged 18 years and above. One hundred and twenty students were recruited but only 95 returned the questionnaires.

Questionnaire

The questionnaire contained specific questions adapted from previously used questionnaires^1-4 and included the biodata of a respondent such as age and sex, the presence of selected oral and non-oral symptoms;³ the intake of drugs and medications and the presence of systemic diseases. The selected oral and non-oral symptoms were based on the study by Sreebny and Valdini³ and included the following: oral dryness, the need to consume fluid regularly, difficulty with masticating and swallowing dry food, difficulty with speech, and burning sensation in the mouth. Others questions were on dryness of the eye, throat, nasal cavities, skin and genital area, recurrent genital and oral infections, constipation and mouth breathing.   Respondents were categorized into 2 groups: xerostomia and non-xerostomia based on their answers to the questions "Does your mouth feel dry constantly?"⁷

Statistical Methods

The data was analyzed with the SPSS package for descriptive statistics. Contigency table analysis was used to test association among different variables. Differences between 2 parameters and groups were tested with Chi-square test. Significance level was set at 5%.

The results showed that about 23% of the subjects in the studied population reported the feeling of oral dryness with no sex differences (Table 1). The prevalence increased significantly with age from about 12.5% in the 18-29 age group to 33% in the age group above 50 years (Table 2). About 20% of subjects had the symptoms for 6 years or more (Fig. 1). Of the selected drugs, only analgesics, vitamins and minerals were not positively correlated to xerostomia (Table 3). Results also showed significant differences between the two groups in many of the selected oral and non-oral signs and symptoms (Table 4).

Most studies on xerostomia have been carried out on community-dwelling or institutionalized adults.^5,9-13  These reports have shown that the prevalence of xerostomia ranged from about 10% among 50 year olds to 40% in people aged 65 years and above. Very few studies and data are available for people under age 50 years especially in very young populations.^3,8 The present study was a cross-sectional evaluation of prevalence of self-reported symptoms of xerostomia in a wide age- range from 18 years old adolescents to adults 50 years of age and above.

The prevalence of xerostomia in this study was 23.2%, which is comparable to reports on fairly similar age groups from other parts of the world with different climatic characteristics. Nederford et al.¹⁴ reported a prevalence figure of 21.3% and 27.3% for Swedish men and women respectively aged between 20 - 80 years of age. Billings et al.¹⁵ also reported a prevalence of 18% and 24% among men and women, respectively in their study of 710 adults aged 19 - 88 years of age in New York area of USA. Therefore, climatic differences may not play a major role in the feeling of oral dryness.

In this study there was no significant difference in prevalence rates between male and females. This however is in contrast to many studies which reported a significantly higher prevalence among women.^7,14,15 Billings observed that this difference became apparent after 50 years of age. Our study covered a much younger age group than most of these studies and may have accounted for the lack of difference between the sexes at this age range.

The relationship between increasing age, salivary gland hypofunction and xerostomia has also been well documented. Many studies, including the present report, suggested an increase in xerostomia with age although there is controversy as to whether there is concomitant reduction in salivary secretion with age.^16-18 According to Sreebny,² it is doubtful whether this age effect may be sufficient to induce xerostomia. Dawes¹⁹ suggested that salivary flow rate has to be reduced by 50% before the feeling of oral dryness could occur. We observed a significant increase in prevalence with age ranging from 12.5% in the12 - 29 age group to 33 % in the 50 year olds. About 80% of the xerostomic subjects reported a duration of 5 years and below, with the remaining 20% reporting a duration of 6 years and above.

A comparative analysis of selected oral and non-oral symptoms showed that there were significant differences between xerostomic and non-xerostomic subjects. Xerostomia was strongly associated with oral symptoms such as feeling thirsty, keeping mouth moist constantly, keeping fluid by the bedside for night use, difficulty in speech and swallowing, mouth-breathing, recurrent oral infections and burning sensation of the tongue. This accords with many studies, which showed that these symptoms could be used for diagnostic criteria of oral dehydration and salivary gland hypo-function.^3,8 However, Dawes¹⁹ opined that the sensation of dry mouth could be triggered by localized areas of dryness since saliva wetting varies from site to site. Therefore, while dry mouth often results from salivary gland hypofunction, it could also be felt by subjects with apparently sufficient amount of saliva.⁷

The use of certain drugs had also been associated with xerostomia. In the present study, the feeling of oral dryness was strongly associated with anti-histamines, anti-obesity, anti-hypertensive, diuretics and hypoglycemic drugs but not with the use of vitamins, minerals and analgesics. We also observed a significant association with the use of cigarette and tobacco.

It was interesting to note that none of those who reported the feeling of oral dryness had actually gone for dental consultation for the condition. This may be due to the fact that in most cases it is not a serious condition as such and subjects can manage the condition on their own. However, as the oral effect of containing oral dehydration may not be known to most people, it is essential that the dental profession includes this symptom in public dental education program for all communities.

Xerostomia is a relatively common symptom among a convenient population of 18-50 year old subjects studied in Jeddah Saudi Arabia affecting 1 in every 5 subjects. The prevalence increased with age with no significant sex differences. It is also strongly associated with many oral, non-oral conditions, symptoms and social habits such as the use of cigarettes and tobacco.

Despite this prevalence, none in the xerostomic group had reported dental consultation and management. An awareness dental education program is recommended in all ages and communities.

Address reprints requests to:

Prof. Nathanael Salako
Faculty of Dentistry, Kuwait University
P.O.Box 24923, Safat 13110, Kuwaite
email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Table 1.  Prevalence of xerostomia according to gender (P<0.15)

Table 3.  Comparison of xerostomic and non-xerostomic patients and use of medications

Table 4.   Comparison of reported symptoms in xerostomia and non-xerostomic patients.

Figure 1. Duration of xerostomia